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Does psychotherapy research inform treatment decisions in private practice?

Psychologists in independent practice (N = 591) were surveyed regarding their approach to treatment decisions, specifically the use of research on empirically supported treatments (ESTs) to inform practice. All participants received a case study of a patient with panic disorder, and half were randomly assigned to receive a research summary on evidence-based treatments for panic disorder (cognitive-behavioral therapy and pharmacotherapy). Practitioners reported that they rely primarily on clinical experiences to inform treatment decisions, although they often consult EST literature. Those who received the research summary were significantly more likely to report they would use an EST. These results indicate that providing information about ESTs can impact practice. Although this sample was more positive about EST research than clinicians are often depicted to be, this study indicates an enduring research-practice gap in clinical psychology.

Decision Making↗

Dental status of 12-year-olds treated in private practice and a school dental service.

Different ways of service provision frequently lead to different services being provided. In the School Dental Service (SDS) in Western Australia, all 5-15-yr-olds are eligible for care free of charge and most avail themselves of the service. The parents of some children choose to use private dentists (typically copaying about 50% of the cost) and their children do not attend the SDS. This study aimed to compare the dental status of 12-yr-olds who attended private dentists with that of matched children enrolled in the SDS. Non-enrolled 12-yr-olds in Perth (F- 0.8 mg/l) were identified and asked to provide background information and participate in clinical examinations. Each non-enrolled participant was matched with a classmate of the same sex. Of 184 non-enrolled children, 100 actually participated. Data on caries experience (DMFT and DMFS), fissure sealants and gingival health (CPITN) were collected by clinical examination. Analyses used Wilcoxon's signed rank, categorical and t-tests and simple linear regression. Caries prevalence was lower in non-enrolled children (0.31) than in enrolled (0.47). Caries experience was also lower in non-enrolled children (mean DMFT 0.71 vs. 0.95, ns). Enrolled children had more FT than non-enrolled (Wilcoxon, P = 0.059) but the mean number of DT in each group was 0.14. Enrolled children had somewhat fewer fissure sealants than non-enrolled children but in enrolled children there was an apparent (P = 0.056) inverse relationship between number of fissure sealants and DMFT scores; this was not the case in the non-enrolled group, suggesting better targeting of fissure sealants in the SDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗

The private practice psychologist and manual-based treatments: post-traumatic stress disorder secondary to motor vehicle accidents.

This paper discusses the issues of providing an empirically validated, manual-based-treatment when viewed from the perspective of a practicing clinical psychologist. The trend for empirically proven treatment is reviewed briefly, and initial data are provided illustrating a manual-based-treatment for post-traumatic stress disorder (PTSD) following a motor vehicle accident. The relatively brief (9-12 session) psychological treatment was effective in reducing PTSD symptoms as measured on the Clinician Administered PTSD Scale, for all 10 subjects. The results are discussed form the practicing clinician's perspective: generalization to a clinical population, ethical concerns of limited treatment goals, individually tailored vs standardized treatments in clinical practice, concerns for co-morbid conditions, and how this type of study might impact on practice in an era of managed health care. Issues of incorporating manual based treatments into clinical practice are discussed, with consideration of gains, the limits and the constraints this would bring to the practice of psychology.

Accidents, Traffic↗